The Centers for Medicare and Medicaid Services (CMS) pays for Medicare inpatient hospital care on the basis of Diagnosis Related Groups (DRGs). Certain DRGs (often referred to as Transfer DRGs) are paid under the Medicare Post Acute Transfer rules, which reduce payments for hospitals that transfer patients to other providers to continue treatment.
Beyond the transferring hospital’s control, a significant number of patients are not treated as planned after being transferred. This results in an unwarranted reduction in the transferring hospital’s Medicare reimbursement. The impact of this issue to US hospitals is in the hundreds of millions of dollars per year.
Properly reviewing the post-transfer care that patients receive and identifying underpayment situations can provide hospitals with a significant revenue boost.
McKay Consulting identifies patients transferred to post-acute care for which Medicare’s payment, upon retrospective review, was less than the transferring hospital was entitled to receive. The retrospective review and recovery process is complex and tedious. Hospitals don’t usually have the level of resources required to validate that post-acute care was in fact provided to the patient. Our experienced reimbursement consultants provide hospitals with the comfort that the recovery effort is appropriate, compliant and effective. In many cases, McKay Consulting can also provide a second review behind another vendor to identify additional post transfer revenue.
Our goal is, and has always been, to provide our clients with the best finance and reimbursement consulting services in compliance with all applicable laws and regulations, while positioning providers for optimal reimbursement.